Bar bar miscarriage avutundaa? Karanam teliyatam ledu? Mother Hospitals lo complete RPL investigation — cause find cheskodam to PGT-A IVF varaku — Dr. E. Prashanthi Reddy tho.
19+ Years Experience · RPL Specialist · PGT-A IVF · Boduppal, Hyderabad
Two or more miscarriages means a full investigation is needed — not just reassurance. At Mother Hospitals, we run a complete RPL workup: chromosomal testing of both partners, uterine scan (3D ultrasound or hysteroscopy), blood clotting panel (APS, thrombophilia), thyroid, and immunological tests. Once the cause is found, targeted treatment — PGT-A IVF, surgery, heparin, thyroid optimisation — significantly improves the chances of a successful pregnancy. Call 97059 93366.
Understanding the cause is the first and most important step — each cause has a specific, effective treatment
The most common cause — 50–60% of first-trimester losses. The embryo has the wrong number of chromosomes (aneuploidy). Frequency increases with maternal age — by 40, over 70% of eggs are chromosomally abnormal. The embryo stops developing and the pregnancy is lost.
Treatment: IVF with PGT-A — tests embryos before transfer, selects only normal ones.
Most Common (50–60%)Uterine septum (most common — fibrous band divides the cavity), fibroids inside the cavity (submucosal), polyps, or Asherman's syndrome (intrauterine adhesions from previous surgery). Embryos implanting on poor blood-supply areas miscarry.
Treatment: Hysteroscopic surgery — corrects septum, removes polyps/fibroids, breaks adhesions.
Structural (10–15%)An autoimmune blood clotting disorder. Antibodies attack phospholipids in placental blood vessels, causing tiny clots that starve the embryo of blood supply. The most treatable cause of RPL — heparin + aspirin reduces miscarriage rates dramatically.
Treatment: Low-molecular-weight heparin injections + low-dose aspirin throughout pregnancy.
Immune (15%)Genetic clotting disorders — Factor V Leiden mutation, prothrombin gene mutation, MTHFR variant, protein C/S deficiency, antithrombin III deficiency. Increase risk of placental blood clots and pregnancy loss, especially in the second trimester.
Treatment: Heparin (with or without aspirin) — often continued throughout pregnancy.
Thrombophilia (5–10%)Thyroid disorders (even mild hypothyroidism with TSH >2.5) increase miscarriage risk. TPO antibodies independently raise risk even when TSH is normal. Poorly controlled diabetes, hyperprolactinaemia, and luteal phase defect also contribute.
Treatment: Levothyroxine to achieve TSH <2.5, progesterone support, prolactin normalisation.
Hormonal (10%)After a full investigation, 50% of RPL couples have no identifiable cause. The good news: natural conception success after unexplained RPL is still 65–75%. IVF with PGT-A can improve outcomes further by selecting chromosomally normal embryos even without a known genetic diagnosis.
Treatment: Progesterone support, IVF with PGT-A, close early pregnancy monitoring, supportive care.
Unexplained (50%)Since chromosomal errors cause the majority of miscarriages, testing embryos before transfer and selecting only normal ones is the single most effective intervention for RPL couples — regardless of age.
Complete cause-finding workup — done once, done right
Blood chromosome analysis for both partners. Identifies balanced chromosomal translocations — where chromosome sections are swapped but no material is lost in the parent. However, embryos can receive unbalanced copies, causing miscarriage. Present in 3–5% of RPL couples. Genetic counselling + IVF with PGT-SR (structural rearrangement testing) is recommended.
3D transvaginal ultrasound reliably detects uterine septum, arcuate uterus, bicornuate uterus, and submucosal fibroids. Diagnostic hysteroscopy gives a direct view of the uterine cavity and can simultaneously treat septum, polyps, and Asherman's adhesions in one procedure.
Lupus anticoagulant (LA), anticardiolipin antibodies (IgG and IgM), anti-β2 glycoprotein-1 antibodies — tested twice, 12 weeks apart, to confirm APS diagnosis. One positive test is not sufficient for diagnosis — persistence is required. APS is confirmed in ~15% of RPL patients and is highly treatable.
Factor V Leiden, Prothrombin G20210A mutation (PCR-based), protein C activity, protein S activity, antithrombin III, homocysteine and MTHFR variant. These are inherited clotting tendencies that may predispose to placental thrombosis and late first-trimester or second-trimester loss.
TSH (target <2.5 mIU/L before and in early pregnancy), free T4, TPO antibodies. HbA1c if diabetes suspected. Prolactin (elevated prolactin causes luteal phase defect). AMH and AFC (ovarian reserve) — important for planning IVF with PGT-A.
Antinuclear antibodies (ANA), anti-dsDNA — to screen for systemic lupus erythematosus (SLE) which increases RPL risk. Natural killer (NK) cell activity testing in selected cases of unexplained RPL where immune implantation failure is suspected. Managed in collaboration with rheumatology when needed.
Every RPL treatment plan at Mother Hospitals is personalised to the specific investigation findings
Embryos biopsied at Day 5 (blastocyst stage). Next-generation sequencing (NGS) analyses all 24 chromosomes. Only chromosomally normal (euploid) embryos transferred. Miscarriage rate drops from 30–40% to under 10%. Most impactful intervention for age-related RPL.
Keyhole surgery through the cervix — no external incisions. Septum resected, polyps removed, adhesions divided. 30–45 minute procedure under sedation. 3-month recovery before trying to conceive. Miscarriage rates return to normal after successful correction.
Low-molecular-weight heparin (Clexane/Fragmin) injections starting before or at the time of a positive pregnancy test. Low-dose aspirin (75–150 mg). Continued throughout pregnancy, stopped at 36–37 weeks. Reduces miscarriage rate from >80% to under 30% in confirmed APS.
Levothyroxine to achieve TSH <2.5 mIU/L before conception and maintained in early pregnancy. Vaginal progesterone from positive test through 12–16 weeks gestation. Selenium supplementation for TPO-antibody positive patients. Prolactin normalisation with cabergoline.
Vaginal progesterone (400–800 mg/day) started at positive pregnancy test — shown to reduce miscarriage rates in women with previous losses. IVF with PGT-A selects chromosomally normal embryos even without a known genetic cause — improves outcomes significantly.
Fortnightly scans from 5 weeks gestation. Serial hCG measurements in early pregnancy. Early detection of any problem allows prompt intervention. Psychological support — anxiety in subsequent pregnancies after loss is significant and is acknowledged and addressed throughout care.
Selecting chromosomally normal embryos before transfer — the most effective strategy for RPL
Full RPL investigation completed. Uterine abnormalities corrected by hysteroscopy. Thyroid optimised. APS/thrombophilia treatment commenced. AMH and AFC assessed to plan stimulation.
Fix all correctable causes before starting IVF
FSH injections stimulate multiple follicles. Goal: retrieve enough eggs to generate multiple blastocysts for PGT-A testing — more embryos tested means higher chance of finding a normal one.
Aim for 4–6 blastocysts for PGT-A — allows selection from multiple options
Eggs collected under sedation. ICSI fertilisation — direct sperm injection into each mature egg. Embryos cultured to Day 5 (blastocyst stage) — the optimal stage for PGT-A biopsy.
ICSI used in all PGT-A cycles to prevent sperm DNA contamination in biopsy
5–8 cells removed from the outer layer (trophectoderm) of each Day 5 blastocyst. The embryo itself is not harmed. Biopsied cells are sent for Next-Generation Sequencing (NGS) analysis of all 24 chromosomes.
Results in 7–14 days. All embryos vitrified (frozen) while awaiting results.
Each embryo is reported as euploid (normal, 46 chromosomes), aneuploid (abnormal — too many or too few chromosomes), or mosaic (mixture). Only euploid embryos are suitable for transfer. Results also show sex chromosomes — sex selection for medical reasons can be discussed.
Understanding your embryo chromosome results — Dr. Prashanthi explains each result in detail
A normal (euploid) embryo is thawed and transferred into a prepared uterus in a subsequent cycle. With a chromosomally normal embryo, implantation rates are 60–70% and ongoing pregnancy rates are 55–65% — regardless of age.
Miscarriage rate after PGT-A FET: <10% vs. 30–40% without testing
Dr. E. Prashanthi Reddy answers the most common questions from RPL patients
Most international guidelines (ESHRE, RCOG) now define recurrent miscarriage as two or more consecutive pregnancy losses. At Mother Hospitals, we begin a full RPL investigation after two consecutive miscarriages — or after even one loss if you are over 35, or after a failed IVF implantation. Early investigation matters because treatable causes like APS can be identified and managed before the next pregnancy attempt.
Rendu leda ataniki misi miscarriage avvadam tarvata complete investigation avasaram. Mother Hospitals lo parental karyotyping (blood chromosome test), uterus scan (3D ultrasound leda hysteroscopy), blood clotting panel (APS, thrombophilia), thyroid test, immunological tests — anni chestam. Karanam telusukunte, targeted treatment — PGT-A IVF, surgery, heparin, thyroid medicine — successful pregnancy possibility chala pedutundi.
PGT-A (Preimplantation Genetic Testing for Aneuploidies) biopsies Day 5 embryos to test all 24 chromosomes. Only chromosomally normal embryos (euploid) are transferred. Because 50–60% of miscarriages are caused by chromosomal errors in the embryo, transferring only tested normal embryos reduces the miscarriage rate from 30–40% to under 10% — the single most effective intervention for RPL.
Yes — absolutely. Even without any treatment, 65% of women go on to have a successful pregnancy after 3 consecutive losses. With proper investigation and targeted treatment, this rises significantly — especially with PGT-A IVF, which gives a <10% miscarriage rate when a normal embryo is transferred. At Mother Hospitals, we have helped many couples who had 3, 4, or even 5 previous losses go on to have healthy babies.
Yes — very effectively. APS is treated with low-molecular-weight heparin injections (Clexane) plus low-dose aspirin (75 mg), started from early pregnancy. This reduces miscarriage rates in confirmed APS from >80% to under 30%. Treatment must continue throughout pregnancy. APS must be confirmed by two positive antibody tests 12 weeks apart — a single positive is not diagnostic. Dr. Prashanthi works with haematology for complex APS cases.
Not always — many women with a small septum conceive and carry normally. However, a uterine septum is the most common correctable cause of RPL. The septum has poor blood supply — embryos implanting on it receive inadequate nutrition and miscarry, typically in the first trimester. Hysteroscopic septum resection is a straightforward 30-minute procedure with excellent outcomes — miscarriage rates return to normal afterwards. All RPL patients have uterine assessment at Mother Hospitals.
Even mildly elevated TSH (above 2.5 mIU/L) is associated with increased miscarriage risk and impaired embryo implantation. Thyroid peroxidase (TPO) antibodies independently raise miscarriage risk through an immune mechanism, even when TSH is normal. Levothyroxine is prescribed if TSH is above 2.5 mIU/L. All RPL patients at Mother Hospitals have TSH and TPO antibody testing as part of the standard workup.
Unexplained RPL is frustrating but does not mean untreatable. Progesterone supplementation from early pregnancy has growing evidence of benefit in RPL. IVF with PGT-A selects chromosomally normal embryos even without a specific diagnosis — significantly improving chances. Most importantly: 65–75% of couples with unexplained RPL go on to have a successful pregnancy in the next attempt, naturally or with support. Close monitoring in early pregnancy — fortnightly scans from 5 weeks — provides both reassurance and early detection of any problem.
RPL investigation workup: ₹8,000–15,000 (karyotyping, thrombophilia panel, 3D ultrasound, APS panel). Hysteroscopic surgery for uterine anomaly: priced separately based on complexity. IVF + PGT-A: ₹99,000 (IVF cycle) + ₹30,000–50,000 (PGT-A testing) depending on number of embryos biopsied. Call 97059 93366 for a personalised RPL treatment plan and cost estimate after your initial consultation.
Physically, most doctors recommend waiting for one normal menstrual cycle before trying again — this allows the uterine lining to recover and helps date a subsequent pregnancy accurately. Emotionally, there is no fixed timeline — each couple heals differently. However, if you have had two or more losses, please do not wait to seek investigation — the investigation itself does not delay trying to conceive and may identify a treatable cause that significantly improves your next attempt.
Mother Hospitals, Boduppal — Dr. E. Prashanthi Reddy — RPL specialist — 19+ samvatsarala anubhavam
Rendu leda ataniki misi pregnancy loss avvadam ni recurrent miscarriage antaru. Idi 1–2% couples ki vastundi. Chala common cause: embryo lo chromosome errors. Kaani idi IVF + PGT-A tho treat cheyyavachu — miscarriage rate 30–40% nundi 10% kanda taggistundi.
IVF lab lo peri Day 5 ki grow ayina embryo nundi few cells teestaamu. Avi lab lo anni 24 chromosomes test chestaru. Only normal embryo (euploid) transfer chestam. Bar bar miscarriage lo idi single most effective treatment — miscarriage rate 10% kanda taggipotundi.
Bar bar miscarriage avutundaa? Ippudey sampradinchandi — karanam telisukoni, successful pregnancy kosam plan chestam.
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